1811136310 NPI number — TODD IAN RODMAN DC,APRN, FNP-BC,CCSP

Table of content: TODD IAN RODMAN DC,APRN, FNP-BC,CCSP (NPI 1811136310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811136310 NPI number — TODD IAN RODMAN DC,APRN, FNP-BC,CCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODMAN
Provider First Name:
TODD
Provider Middle Name:
IAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC,APRN, FNP-BC,CCSP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811136310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9618 EXBURY COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-234-6063
Provider Business Mailing Address Fax Number:
561-451-1223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9960 SOUTH CENTRAL PARK BLVD
Provider Second Line Business Practice Location Address:
#375
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-313-9119
Provider Business Practice Location Address Fax Number:
561-228-5959
Provider Enumeration Date:
02/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH9696 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN11038867 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH9696 . This is a "LICENSE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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